Next to apoplexy, injuries of the head are most important. The symptoms presented by the patient will often be nearly the same as those of apoplexy. If the skull is fractured, and the depressed bone is exerting pressure upon the brain substance, there is a similar state of affairs to that which exists in apoplexy. Any return to consciousness must be taken advantage of for the administration of the Sacraments. As a rule, it is impossible to tell the extent of the injury or to forecast the ultimate result. A very characteristic set of symptoms develops sometimes after injuries in the temporal region or just above it. For a short time up to an hour or two after the injury, the patient is unconscious. Then he comes to for a while, but relapses into unconsciousness, from which he will usually not recover except after an operation. The explanation of this succession of symptoms is that the primary unconsciousness is due to shock--concussion or shaking up of the brain. The injury has, however, also caused a rupture of an important artery which occurs in one of the membranes of the brain in this region, the middle meningeal artery. During the state of shock blood pressure is low and hemorrhage is not severe. When consciousness is regained, blood pressure goes up and the laceration of the middle meningeal artery, already spoken of, provides an opening for the exit of considerable blood, which clots in this region and presses upon the brain, causing the subsequent unconsciousness. As a rule, the patient's only hope is in operation with ligature of the torn artery. The condition is always very serious, and complete precautions as to the possibility of fatal termination should be taken, as soon as consciousness is regained after the blow, in any case where the head injury has been severe enough to cause more than a momentary loss of self-possession. No one can tell whether there may be further change or not, and if this happens it will be in the form of an unconsciousness gradually deepening until relieved by operation or ended by death. {148} Tumours of the brain often produce death, but usually give abundant warning of their presence. The symptoms by which the physician diagnoses the presence of a brain tumour are vertigo, headache, vomiting, usually some eye trouble, and frequently some interference with the motion of some part of the body, because of pressure exerted upon the nerve centres which preside over its motions. Brain tumours are especially liable to develop in two classes of cases--in patients who are suffering from tuberculosis in its terminal stages or from syphilis. Where patients are known to have either of these diseases and present any two of the symptoms of brain tumour that I have mentioned, it is well to suggest at least the preliminary preparation for a fatal termination. Sometimes states of intense persistent pain, or of mental disturbance, develop in these cases and make the administration of the Sacraments unsatisfactory.